Thursday, July 19, 2007

Campaign for Tobacco-Free Kids and Other Health Groups Oppose Elimination of Nicotine, Menthol and Clove from Cigarettes; True Colors Now Show

Despite claiming to be overwhelmingly interested in saving lives, fighting Big Tobacco, protecting kids from addiction to cigarettes, and ending special protections for the tobacco industry, the Campaign for Tobacco-Free Kids (TFK) and three other health groups - the American Lung Association (ALA), American Cancer Society (ACS), and American Heart Association (AHA) - are opposing amendments to the proposed FDA legislation that would greatly strengthen it by allowing the Food and Drug Administration (FDA) to remove the nicotine from cigarettes, prohibiting the use of menthol and clove as primary flavorings in cigarettes, and increasing the size and strength of cigarette warning labels.

Here is what our leading anti-smoking and health organizations are opposed to, despite the fact that they repeatedly claim that their primary desire is to end special protections for Big Tobacco, curtail the recruitment of youth smokers, drastically reduce smoking, and save millions of lives:

1) The AHA, ALA, ACS, and TFK oppose an amendment that would allow the FDA to eliminate the nicotine from cigarettes.

2) The AHA, ALA, ACS, and TFK oppose an amendment that would ban the use of menthol as a primary flavoring in cigarettes, although they support a ban on all other flavors, including "strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee."

3) The AHA, ALA, ACS, and TFK oppose an amendment that would ban the use of clove as a primary flavoring in cigarettes, although they support a ban on all other flavors, including "strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee."

4) The AHA, ALA, ACS, and TFK oppose an amendment that would increase the size of the required warning labels from 30% to 50% of the pack and would require graphic picture warnings such as have been effective in countries such as Canada in reducing smoking.

The Rest of the Story

The rest of the story is that these health groups have shown their true colors. When it really comes down to it, they have no interest whatsoever in promoting measures that would actually be effective in drastically reducing smoking. Instead, they are intent upon granting Philip Morris' wish of permanently institutionalizing cigarettes. And they are content to support a watered down bill that sacrifices health protection to tobacco industry profits, writes racial discrimination in health protection into law, and makes sure that tobacco companies can continue to recruit youth smokers using flavorings that are actually common (while banning those which have never been, nor ever will be used anyway).

Let's take these amendments one by one:

1) The AHA, ALA, ACS, and TFK oppose an amendment that would allow the FDA to eliminate the nicotine from cigarettes.

If the health groups were sincere in their claim that they desire to give the FDA the authority to require cigarettes to be non-addictive, then there is absolutely no reason for them to oppose Senator Enzi's amendment #2, which would explicitly allow the FDA to eliminate the nicotine from cigarettes. Under the provisions of the current bill, the FDA could lower nicotine yields, but not get rid of the nicotine entirely.

As I have explained in detail previously, lowering nicotine yields is about the worst thing that the FDA could do from a public health standpoint. Reduced nicotine yields leads smokers to compensate (to smoke more heavily and to smoke more cigarettes) in order to maintain nicotine levels in their blood. This increases their tar exposure and as a result, their cancer and lung disease risk may actually increase. Lowering nicotine yields would be a public health disaster.

The only potential virtue of allowing the FDA to regulate nicotine would be if the Agency eventually eliminated the nicotine, so that cigarettes would lose much of their addictive potential. If the health groups are serious about supporting this idea, then why are they not supporting this amendment which makes it clear that the intent of Congress is to allow FDA to get rid of the nicotine?2) The AHA, ALA, ACS, and TFK oppose an amendment that would ban the use of menthol as a primary flavoring in cigarettes, although they support a ban on all other flavors, including "strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee."

This exposes what the health groups are really doing here. They are basically supporting window dressing. They want to be able to say that they are doing something to protect the public's health, but when it really comes down to it, they want to tie FDA's hands to deal with the real issues, and allow the FDA to address the issues that are non-issues to begin with.

Menthol is by far the most common flavoring used in cigarettes. It is very popular among African American smokers in particular. In contrast, I am not aware of any cigarettes that feature strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee.

When was the last time you walked into a store and noticed the pineapple Marlboros on the shelf? How frequently do you see someone lighting up from a pack of cherry-flavored Camels? Has anyone ever asked you if you wanted to try a grape Newport?

The health groups are perfectly willing to require the elimination of flavorings that aren't actually used in cigarettes. But they want to protect the tobacco companies' ability to add flavorings that are actually used to recruit youth smokers.

In addition, the groups are supporting what amounts to writing racial discrimination in health protection into the law. To these groups, the idea of white youths being enticed by flavorings is unacceptable. However, it is perfectly acceptable for black youths to be enticed by menthol.

Right on the mark, Senator Enzi's amendment #11, which would add menthol to the list of prohibited flavorings, lists as its purpose "To protect African-American youth." The health groups don't seem interested in protecting African American youths, only white youths.3) The AHA, ALA, ACS, and TFK oppose an amendment that would ban the use of clove as a primary flavoring in cigarettes, although they support a ban on all other flavors, including "strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee."

Once again, this exposes what the health groups are really doing here. They are supporting window dressing. They want to be able to say that they are doing something to protect the public's health, but when it really comes down to it, they want to tie FDA's hands to deal with the real issues, and allow the FDA to address the issues that are non-issues to begin with.

Clove is not only the most common flavoring used in cigarettes marketed in Indonesia, but clove cigarettes are becoming increasingly popular in the United States. In fact, in some areas of the country, clove cigarettes make up a substantial proportion of youth market share. In contrast, I am not aware of any cigarettes smoked by youths that feature strawberry, grape, orange, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee.

Again, the health groups are perfectly willing to require the elimination of flavorings that aren't actually used in cigarettes. But they want to protect the tobacco companies' ability to add flavorings that are actually used to recruit youth smokers.4) The AHA, ALA, ACS, and TFK oppose an amendment that would increase the size of the required warning labels from 30% to 50% of the pack and would require graphic picture warnings such as have been effective in countries such as Canada in reducing smoking.

This is a no-brainer. There is strong evidence that graphic warning labels are effective in reducing smoking. And obviously, a larger warning is going to be more effective than a larger one. But again, since this is a measure that would actually have an impact on smoking (as opposed to being merely window dressing), the health groups oppose it.

Once again, the health groups are protecting Big Tobacco profits at the expense of the protection of the public's health.

What This All Means

What this means is that the Campaign for Tobacco-Free Kids, American Cancer Society, American Heart Association, and American Lung Association are the best friends that Philip Morris could ask for. They are doing everything they can to protect Philip Morris profits at the expense of the public's health.

More importantly, what it means is that these organizations are full of baloney when they talk about their desire to end special protections for Big Tobacco. What they are doing is supporting the most special protections for Big Tobacco imaginable. These groups are opposing the very measures that could actually do something to put a dent in smoking. And they are supporting all the measures that would do nothing to curtail smoking, but would allow the companies to appear to the public as if they are complying with stringent safety regulations because they are concerned about the health of their customers.

Despite all my criticism of these groups over the past months, they actually had a chance to redeem themselves by supporting these amendments to strengthen the legislation and eliminate some of the glaring loopholes that were inserted specifically for Philip Morris.

But the groups - all of them - have failed miserably. It is a supreme disappointment to find out that the goal of being able to stick a feather in the cap is more important than actually doing something meaningful to protect the public's health.

I'm all for regulation of public health hazards. But if you're going to let Philip Morris write those regulations, then count me out.

Not so for the health groups. We now know that they are perfectly willing to stand shoulder-to-shoulder with Philip Morris and let the nation's leading cigarette company dictate the terms under which the FDA will be forced to approve cigarettes.

The Campaign for Tobacco-Free Kids, American Cancer Society, American Heart Association, and American Lung Association have sold out the public's health to protect tobacco industry profits. What a sad chapter in tobacco control and public health history.

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About Me

Dr. Siegel is a Professor in the Department of Community Health Sciences, Boston University School of Public Health. He has 32 years of experience in the field of tobacco control. He previously spent two years working at the Office on Smoking and Health at CDC, where he conducted research on secondhand smoke and cigarette advertising. He has published nearly 70 papers related to tobacco. He testified in the landmark Engle lawsuit against the tobacco companies, which resulted in an unprecedented $145 billion verdict against the industry. He teaches social and behavioral sciences, mass communication and public health, and public health advocacy in the Masters of Public Health program.